Is there still a case to make Covid vaccination mandatory?

Earlier in the week there were apparently chaotic scenes at a vaccination centre in Leith, where a number of people were refused entry because of a sudden surge in people hoping to get their Covid jab, writes Aleksandar Kocic.

Local media in Edinburgh reported that the surge was caused by the implementation of the Scottish Government’s vaccine passport scheme, which was introduced last week.

NHS Lothian however emphasised that high turnout for multiple programs – including Covid-19 jabs for teenagers, third doses for the clinically vulnerable and flu shots for the elderly – were behind the increased pressure on services.

These occasional snags, while certainly not pleasant for those involved, actually indicate that the Covid passport scheme seems to be working. It is getting people, mostly youngsters, to get the vaccine so they can have a carefree fun night out. And whatever the reason, it is good to see queues outside vaccination centres, because getting the jab is really the best and easiest way out of the pandemic.

In Scotland almost four million people have got the second dose of the Covid-19 vaccine and almost 90 percent of people aged 18 and over have been jabbed, with rates of 100% or close in most vulnerable age groups. So far, so good.

But could all this have been achieved faster? And will it be easy to get people back in the queue for the third dose, or for the regular booster shots every now and then, as some experts predict might be necessary? In other words, do we need mandatory Covid-19 vaccination?

READ MORE: Boosters ‘could wait three to five years’, says US expert

So far only four countries or territories have introduced full vaccine mandates. Most have opted for a combination of sticks and carrots – usually small rewards for rolling your sleeve up or not so small penalties for refusing to do so.

In the traditionally vaccine-hesitant France there was a surge in vaccination appointments as soon as President Macron announced that people would be barred from entering cafes, restaurants or trains unless they can produce a health pass showing they are Covid negative or have been fully vaccinated.

Americans have been offering all kinds of incentives to people to get the jab, from free beer and cannabis joints to guns or lottery tickets. Italy, on the other hand, has introduced strict measures that basically prevent unvaccinated people from returning to work.

Is this mandatory vaccination through the back door?

Roland Pierik, associate professor of legal philosophy at the University of Amsterdam and a member of the Dutch Health Council, disagrees. He says that is how vaccine opponents are framing the issue.

“We have a moral duty to make sure that we don’t infect others,” said Prof Peirik.

“And you can do your duty in various ways. One is to stay at home. Or to go out and test or take the vaccine.

“No one requires you to take the vaccination. There’s no police coming to your home, but your choices have consequences, whether you like it or not. I understand people hate the state interfering with their life. But I don’t see it as mandatory vaccination.

“I would say it is mandatory when you are fined and thrown in jail, when action under criminal law is taken against you.”

READ MORE: Almost 400 fully-vaccinated Scots died after restrictions lifted in August

Here in Scotland the Government has just introduced Covid passes that enable people to go to large events. Young people seem to be keen to get the jab so they can go out at night. Is that a stick or a carrot?

Dorit Reiss, professor at Hasting Law School at the University of California, said: “I think it makes sense to see going to nightclubs as an incentive rather than a coercive mandate, because it’s a luxury in a sense, you don’t have to go to a nightclub.

“Making vaccination an easy and attractive choice can be a really big help. Whether it’ll be enough to make mandates unnecessary will really depend on the situation [in a particular country or region].”

So, no clubbing without the jab. At the same time, students at Scottish universities can attend lectures on campuses without any checks, which is not the case in many other countries. Mandatory vaccination has not been introduced in any other sector in Scotland either.

The Government says it wants to ensure that people are able to make informed choices about whether or not to accept the offer of vaccinations. But is there an argument that the vaccination process could have been completed sooner with mandates? After all, people are still getting ill, ending up in hospitals and dying from Covid. The Delta variant is around and nobody knows if there will be other, more dangerous, variants of the coronavirus.

“In an ideal world, you don’t want to mandate a new vaccine as hesitancy towards a new vaccine is completely normal,” said Prof Reiss.

“It’s natural to be nervous about a new product, especially a product that’s been developed relatively fast. In an ideal world, the minority that doesn’t vaccinate would be protected by the majority that does vaccinate. However, we’re not in normal times; the Delta variant changed the game on us.

“So, under these circumstances, your choices are to let the virus rage or push vaccination up. And you don’t have time to work through concerns because people are dying every day. In that situation mandates are less worse than letting [the virus] rage.”

READ MORE: Retired medics put off return to NHS due to ‘complex’ process and ‘inappropriate’ job offers 

This is essentially the ethical argument for mandatory vaccination, typically based on ensuring the best outcome for the greatest number of people.

Julian Savulescu, the director of the Oxford University’s Uehiro Centre for Practical Ethics, recently wrote that from an ethics perspective, a number of conditions should be met in order to justify a mandatory vaccination programme, including that: “there is a grave threat to public health”, “mandatory vaccination has a superior cost/benefit profile compared with other alternatives” and “the level of coercion is proportionate”.

Then there are the usual liberal arguments against mandatory vaccination, which essentially say that people should be free to decide for themselves if they wish to get the jab. This seems to be the route taken by the Scottish Government.

But there is also a view that mandates would be counter-productive.

Peter Newman, a sociologist at the University of Toronto, said: “Mandating vaccination would risk turning a highly effective and routine public health intervention into a contentious battleground. To some extent, that’s already happened in the US not because of mandates, but because of the unfortunate over-politicisation of vaccination by the former incompetent administration.

“With mandates you risk losing 30 or 40% of the population, not all of whom are diehard, anti-vaxxers; some of them just haven’t had access yet. Some of them come from marginalised populations, like in North America black and indigenous people or other people of colour who have not necessarily been infected by conspiracy theories but have legitimate mistrust of government and public health because of things that have happened to them in the past. All you need to do really is promotion, education and respect.”

And while the vaccination in the West is going quite well, the situation elsewhere is less rosy. In Eastern Europe Romania has managed to vaccinate around 30% of the adult population; Bulgaria only around 20%.

Serbia, which was an early success story when it acquired large quantities of various vaccines and invited people to choose the one they wish to get, has now been stuck at around 40% while the virus is raging again in the country and hospitals are full with Covid patients. Yet, there has been no mention of mandates in any of those, or other, more authoritarian countries such as Russia or China.

Prof Pierik suspects that in Russia the reason for possible reluctance to introduce mandates may be earlier mistakes.

He said: “Putin started off on the wrong foot. He already started vaccinating the population before all the tests were finished. And I think that’s a disaster, because at the end of the day, vaccination is a case of trust.”

Prof Reiss thinks that in societies like the Chinese the state does not even have to say there’s a mandate to make people take the vaccine if it has general control over people’s lives.

She said: “Whether or not there is a vaccine mandate is probably less important than what’s the reality. If the reality is, when you’re going into your job, you’re getting vaccinated coming in, period, they may not need to announce that.”

Other parts of the world, meanwhile, have a different kind of a problem to deal with.

Africa and Latin America might not have a need for mandates simply because they don’t have enough vaccines. Only nine of Africa’s 54 countries had met the goal of vaccinating 10% of their people by the end of September.

In Latin America, the situation is slightly better, but with huge regional variations. Which brings us to the old World Health Organisation warning that, with or without vaccine mandates, “no one is safe until everyone is safe”.

 

Aleksandar Kocic is a journalist and Programme Leader for BA Journalism at Edinburgh Napier University

The Herald Scotland

The Herald Scotland

The Herald is a Scottish broadsheet newspaper founded in 1783. The Herald is the longest running national newspaper in the world and is the eighth oldest daily paper in the world. The title was simplified from The Glasgow Herald in 1992